Republican health plan seen as a major setback for hepatitis C Medicaid patients

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Sony Salzman

Sony Salzman is an award winning journalist living in Brooklyn, New York and the co-managing editor of GlobalHealthHub. She has been published in The Boston Globe, Al Jazeera America, The Body, WBUR and NovaNext. You can find her on Twitter, LinkedIn or email her directly at sonysalz@gmail.com.

Amid a growing hepatitis C epidemic, federal austerity measures seen as a setback to infection control. 

By Sony Salzman

It’s been nearly 20 years since Lisa was diagnosed with hepatitis C, a virus she says she probably contracted because of injection drug use many years ago. Now healthy and sober, recently the grandmother of two sought treatment for her infection, which can cause liver cancer and other health problems if left untreated.

Her doctor prescribed a drug called Harvoni, but her Medicaid insurance plan denied treatment, explaining that Lisa is not sick enough to qualify.

“I was shocked,” said Lisa, who asked to only be identified by her first name only. “It’s like denying somebody a wheelchair if they can’t walk.” Drugs like Harvoni are seen as the best weapon to end hepatitis C, a blood-borne infection that is on the rise because of the opioid epidemic now sweeping the nation.

An estimated 3.5 million Americans have hepatitis C, a virus that kills more people very year than HIV and tuberculosis. When the first modern hepatitis C cure was approved in 2013 at $84,000 per treatment, Medicaid programs across the country threw up a blockade of treatment restrictions to control costs. Even as of November 2016, many Medicaid programs were dragging their feet to comply with a federal Center for Medicaid Notice to provide drugs for covered patients.

However, after years of advocacy work and steeply discounted prices, many state programs have begun to ease rules blocking treatment to Medicaid-covered patients. Doctors and public health experts saw these policy changes as steps in the right direction, but recently proposed government austerity measures mean people like Lisa are even less likely to get treatment – and could lose their insurance coverage entirely.

Today, the Senate is back in session  after a week-long break, with Majority Leader Mitch McConnell (R-Kentucky) unable to rally the votes needed to pass the Better Care Reconciliation Act before the July 4 holiday. Similar to its predecessor in the House, the Senate healthcare proposal would strip $800 billion in federal Medicaid funds. Such a stark budget cut would intensify the need for States to focus even more on managing the cost of drug spending.

The Congressional Budget Office estimated that under the plan, 23 million Americans would lose their insurance. Of those 23 million, a significant percent have hepatitis C, said Dr. Paul Pockros, MD, Scripps Clinic Torrey Pines, La Jolla, Calif. “Acute hepatitis C will get worse” if so many low-income people lose their insurance, he said.

Meanwhile, President Donald Trump has proposed gutting the Office of National Drug Control Policy, an executive office branch that tries to combat illegal drug use in the United States. The president’s 2018 budget would slash the Office’s budget by 95%, from $388 million to $25 million.

If both austerity measures come to pass, experts fear it would create a perfect storm in hepatitis C prevention and treatment. Threats to Medicaid funding, pared with a growing opioid crisis that spreads hepatitis C through needle sharing, means the hepatitis C epidemic could spiral further out of control. New hepatitis C cases have skyrocketed in recent years because of injection drug use among young people, according to the CDC. From 2010 to 2015, the number of new infections nearly tripled in the United States, with the highest rate of new infections among 20-29 year olds who inject drugs.

Although the first modern cures for hepatitis C were approved four years ago, the disease is still responsible for more deaths in the United States than 60 other infectious diseases combined, according to the CDC. If proposed austerity measures to Medicaid and the Office of National Drug Control Policy are adopted, the United States may have a harder time meeting the World Health Organization’s 2030 goal of eliminating hepatitis C as a major global threat.